Summary & Overview

HCPCS G8428: Medication List Not Documented as Obtained/Reviewed

HCPCS Level II code G8428 indicates that the current medication list was not documented as obtained, updated, or reviewed by the eligible clinician and no reason for the omission was recorded. Nationally, this code highlights gaps in medication reconciliation documentation, an important patient-safety and care-coordination measure. Proper documentation affects quality reporting, compliance, and continuity of care across outpatient settings. Key payers included in this coverage overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn what G8428 represents, why documentation of medication reconciliation matters for clinical quality and administrative reporting, and which major payers are relevant to coverage and reporting discussions. The summary also outlines where this service typically occurs—primarily outpatient and ambulatory care visits—and what information is available or missing in the input. Data not available in the input includes specific associated taxonomies, ICD-10 pairings, related billing codes, and payer-specific reimbursement details. The publication provides benchmarks, policy context, and practical coding notes so stakeholders can understand the implications of G8428 in national quality measurement and claims documentation workflows.

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Billing Code Overview

HCPCS Level II code G8428 denotes Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given. This code represents a documentation gap in medication reconciliation where the clinician has not recorded that the patient’s medication list was obtained, updated, or reviewed, and no reason for the omission is provided.

Service type: Documentation of medication reconciliation / medication list review
Typical site of service: Outpatient clinic or ambulatory care settings where clinicians are expected to document medication lists and reconciliation during visits

Clinical & Coding Specifications

Clinical Context

A primary care clinician or outpatient specialist documents medication reconciliation as part of an office visit for a chronic disease management or transitional care encounter. The patient presents for follow-up after hospitalization, emergency department discharge, or routine chronic care visit. During the visit, the clinician attempts to obtain, review, or update the patient’s current medication list, including prescriptions, over-the-counter drugs, and supplements, but the record does not document that the medication list was obtained, updated, or reviewed and no reason is recorded. The service type is a quality reporting/healthcare process measure failure related to medication reconciliation (billing code G8428). Typical sites of service include ambulatory clinic, physician office, outpatient specialty clinic, or transitional care setting where clinicians perform medication reconciliation and document the medication list. A realistic patient scenario: a 68-year-old patient with hypertension and type 2 diabetes presents for a follow-up visit after hospital discharge. The clinician completes the medical history and exam but the encounter note lacks documentation that the patient’s current medication list was reviewed or updated, and no reason for omission is recorded. This omission triggers the G8428 billing-level quality code indicating documentation is missing for medication reconciliation.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When documentation supports substantially greater effort or complexity for medication reconciliation beyond typical expectations (rare for `G8428`).
`23`	Unusual anesthesia	Not typically used for this service; included for completeness but generally not applicable.
`52`	Reduced services	When the medication reconciliation service was partially performed but not completed as documented.
`53`	Discontinued procedure	When medication reconciliation was initiated but terminated due to patient condition or other legitimate reason.
`54`	Surgical care only	Not applicable to medication reconciliation; retained for completeness.
`55`	Postoperative management only	Not applicable to this nonoperative service.
`56`	Preoperative management only	Not applicable to this nonoperative service.
`62`	Two surgeons	Not applicable to medication reconciliation.
`AS`	Ambulatory surgical center	Use when billing originates from an ambulatory surgical center, if applicable to associated services.
`CO`	Workers' compensation	Use when the claim is related to workers' compensation payor rules.
`CQ`	Service furnished by auxiliary personnel in a CAH	Use when service is furnished by auxiliary personnel in a Critical Access Hospital under applicable billing rules.
`QK`	Medical direction of two or more assistants	Not typically applicable; included when applicable to associated procedures requiring assistance.
`QX`	Service performed by a certified registered nurse anesthetist (CRNA)	Not applicable to medication reconciliation.
`QY`	Service performed by a physician assistant under physician supervision	Use when an advanced practice provider performed the medication reconciliation under physician supervision per payor rules.
`SH`	Physician performing assistant-at-surgery	Not applicable to this service.
`SJ`	Physician assistant, nurse practitioner services	Use to indicate the service was provided by a physician assistant or nurse practitioner when payor requires this modifier.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly perform medication reconciliation during outpatient visits.
`207R00000X`	Internal Medicine	Internists manage chronic disease and perform medication reviews at follow-up visits.
`208000000X`	General Practice	General practitioners perform medication list reconciliation in ambulatory settings.
`363A00000X`	Nurse Practitioner	Nurse practitioners frequently complete medication reconciliation and document in the chart.
`363L00000X`	Physician Assistant	Physician assistants commonly perform medication reconciliation under supervision or per scope of practice.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I10`	Essential (primary) hypertension	Common chronic condition requiring multiple medications; medication reconciliation is important to prevent interactions and errors.
`E11.9`	Type 2 diabetes mellitus without complications	Chronic disease frequently managed with multiple agents; medication list review is standard at follow-up.
`Z91.120`	Patient's intentional underdosing of prescription medication regimen	Relevant when medication adherence or accuracy of the medication list is in question during reconciliation.
`Z99.2`	Dependence on renal dialysis	Patients with complex regimens and dialysis schedules require careful medication review.
`I50.9`	Heart failure, unspecified	Heart failure patients often have complex polypharmacy where medication reconciliation is critical.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common visit code during which medication reconciliation should be performed and documented; lack of documentation may prompt `G8428`.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used for more complex visits where thorough medication review is expected; omission of documentation may trigger `G8428`.
`99496`	Transitional care management services with high complexity medical decision making	Often includes medication reconciliation after hospital discharge; failure to document the medication review may relate to `G8428`.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per month	Medication reconciliation is a component of care management services; documentation failure can align with `G8428`.
`90832`	Psychotherapy, 30 minutes with patient	Behavioral health visits may include medication list review for psychotropic medications; omission of documentation would be reflected by `G8428`.